Provider Demographics
NPI:1528416948
Name:FULLEX, DOROTHY L (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:FULLEX
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3573
Mailing Address - Country:US
Mailing Address - Phone:843-366-2714
Mailing Address - Fax:843-366-2455
Practice Address - Street 1:1120B 2ND AVE S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3108
Practice Address - Country:US
Practice Address - Phone:843-366-2714
Practice Address - Fax:843-366-2455
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20234363LF0000X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily